Usage
- This medication is primarily prescribed for the treatment of chronic constipation and the prevention of hepatic encephalopathy.
- Its pharmacological classification is an osmotic laxative.
- Briefly, lactitol is poorly absorbed and metabolized into short-chain fatty acids by colonic bacteria. These acids increase osmotic pressure, drawing water into the colon, softening stool, increasing stool volume, and stimulating bowel movements. Benzoic acid serves as a preservative. In hepatic encephalopathy, the lower colonic pH from lactitol reduces ammonia absorption.
Alternate Names
- Lactitol monohydrate + Benzoic acid
- Lactitol + Benzoic acid
- Brand names vary depending on the region and manufacturer. Examples include Lacsyp, Gutclear, Lactomax, Eva Q, ESHCARE, Pizensy, Laxitol, and Lactihep.
How It Works
- Pharmacodynamics: Lactitol exerts its laxative effect by increasing osmotic pressure in the colon, leading to increased water retention and softened stools. It also acidifies colonic contents, which in patients with hepatic encephalopathy, reduces the absorption of ammonia. Benzoic acid has no significant pharmacological activity at the dose present.
- Pharmacokinetics: Lactitol is minimally absorbed (0.5-2%) in the small intestine. It reaches the colon largely unchanged, where it is fermented by gut bacteria into short-chain fatty acids (primarily lactic acid and acetic acid). These fatty acids contribute to the osmotic effect. A small amount of absorbed lactitol and its metabolites is excreted in the urine, while the remainder is eliminated in the feces. Benzoic acid is rapidly absorbed and primarily conjugated with glycine in the liver to form hippuric acid, which is then excreted in the urine.
- Mode of Action: Lactitol is a non-digestible disaccharide analog of lactulose. Within the colon, it is metabolized by saccharolytic bacteria into short-chain fatty acids (acetic and lactic acid). The increased concentration of these fatty acids increases the osmotic pressure, drawing water into the intestinal lumen. This results in an increased stool water content and accelerates colonic transit. Lactitol also lowers colonic pH, which traps ammonia in its ionized (NH4+) form.
- Elimination Pathways: Lactitol is mostly eliminated in feces as short-chain fatty acids; a small amount is absorbed and excreted in urine. Benzoic acid is extensively metabolized by the liver to hippuric acid and excreted in the urine.
Dosage
Standard Dosage
Adults:
- Constipation: Initially 20-30 ml (containing 10g of lactitol per 15ml) orally once daily with a meal. The dose can be adjusted (10-15 ml/day) to produce one soft stool daily. This may be administered as a single dose or divided into two to three doses.
- Hepatic Encephalopathy: 30-45 ml orally, divided into three or four doses daily, taken with meals. The dose can be adjusted as needed.
Children:
- Constipation: 0.25-0.4 g/kg/day (equivalent to approximately 2.5 to 4 ml/kg/day of a 10g/15ml syrup), administered as a single dose with a meal, and adjusted to produce one stool daily. For children below six years of age, the dose should not exceed 10 ml/day.
- Hepatic Encephalopathy: Dosage recommendations for hepatic encephalopathy in children vary and should be determined on a case-by-case basis by a physician.
Special Cases:
- Elderly Patients: No specific dose adjustment. Titrate dose to effect and monitor electrolyte levels.
- Patients with Renal Impairment: No specific dose adjustment. Monitor electrolyte levels.
- Patients with Hepatic Dysfunction: No specific dose adjustment, but caution should be exercised in patients with severe hepatic dysfunction.
- Patients with Comorbid Conditions: Close monitoring is recommended for diabetic patients due to the presence of small amounts of free galactose.
Clinical Use Cases
The specific use cases you mentioned (Intubation, Surgical Procedures, Mechanical Ventilation, Intensive Care Unit (ICU) Use, Emergency Situations) are not typical indications for this medication. Its primary uses remain constipation and hepatic encephalopathy management. Bowel preparation for diagnostic or surgical procedures might be an off-label use, but consult specialist guidelines and consider alternative agents.
Dosage Adjustments
Dose reduction might be needed if persistent loose stools occur. Electrolyte monitoring is essential, especially in the elderly and those with long-term use. Close clinical monitoring is recommended for patients with severe hepatic or renal impairment.
Side Effects
Common Side Effects:
- Abdominal distension
- Cramps
- Flatulence
- Diarrhea (especially with higher doses)
Rare but Serious Side Effects:
- Severe flatulence, nausea, and epigastric pain requiring discontinuation
- Dehydration and electrolyte imbalances (especially with excessive diarrhea)
Long-Term Effects:
- Electrolyte imbalances (with prolonged use)
- Dependence on laxatives for bowel movements (with prolonged use)
Adverse Drug Reactions (ADR):
- Anaphylaxis (rare)
- Severe electrolyte imbalances (e.g., hypokalemia, hyponatremia)
Contraindications
- Hypersensitivity to lactitol or any component of the formulation
- Galactosemia
- Intestinal obstruction or suspected obstruction
- Undiagnosed abdominal pain
- Rectal bleeding
Drug Interactions
- Other oral medications: Lactitol may interfere with the absorption of other oral medications. Administer other medications at least two hours before or after lactitol.
- Some antibiotics (e.g., neomycin): May increase the risk of lactitol-induced diarrhea.
Pregnancy and Breastfeeding
- Pregnancy: While animal studies haven’t shown fetal harm, human data are limited. Use only if clearly needed and the potential benefits outweigh the risks. Discuss with a physician.
- Breastfeeding: Due to minimal absorption, lactitol is considered generally safe during breastfeeding, but consult a physician.
Drug Profile Summary
- Mechanism of Action: Osmotic laxative, increases water content of stool and stimulates bowel movements. Reduces ammonia absorption in hepatic encephalopathy.
- Side Effects: Abdominal distension, cramps, flatulence, diarrhea, electrolyte imbalances.
- Contraindications: Galactosemia, intestinal obstruction, undiagnosed abdominal pain.
- Drug Interactions: Limited data, potential for altered absorption of concomitant oral medications.
- Pregnancy & Breastfeeding: Limited human data in pregnancy; generally safe during breastfeeding.
- Dosage: Refer to dosage section above for details.
- Monitoring Parameters: Stool frequency, electrolyte levels, fluid balance.
Popular Combinations
Lactitol is not typically used in combination with other drugs in a fixed-dose formulation, except for the preservative benzoic acid. However, in the management of hepatic encephalopathy, it may be used alongside other therapies like non-absorbable antibiotics (e.g., rifaximin).
Precautions
- General Precautions: Assess for contraindications, monitor fluid and electrolyte levels, especially with long-term use.
- Specific Populations: See “Dosage - Special Cases” and “Pregnancy and Breastfeeding” above.
- Lifestyle Considerations: Maintain adequate fluid intake, especially water.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Benzoic Acid + Lactitol?
A: Refer to the detailed dosage guidelines above.
Q2: How does Lactitol differ from Lactulose?
A: Lactitol is more palatable, better tolerated, and has a more predictable cathartic activity than lactulose.
Q3: Can this medication be used for opioid-induced constipation?
A: Although osmotic laxatives can be used in opioid-induced constipation, lactitol specifically may not be the first-line agent. Consult specialist guidelines for recommendations.
Q4: How long does it take for Benzoic Acid + Lactitol to work?
A: The laxative effect typically occurs within a few hours, but it may take up to 2-3 days in some cases.
Q5: What are the signs of Lactitol overdose?
A: Excessive diarrhea, dehydration, abdominal cramps, and electrolyte imbalances.
Q6: Can I take other medications while using this syrup?
A: Administer other oral medications at least two hours before or after lactitol to avoid potential absorption issues.
Q7: What are the dietary recommendations while taking this medication?
A: Maintain adequate fluid intake (at least 6-8 glasses of water per day).
Q8: Is it safe to use in patients with inflammatory bowel disease?
A: No. Lactitol is contraindicated in patients with acute inflammatory bowel disease (e.g., ulcerative colitis, Crohn’s disease).
Q9: Should diabetic patients be cautious when using this medicine?
A: Yes, some caution and monitoring may be necessary due to the small amounts of free galactose in the syrup. Blood glucose should be monitored as necessary.
Q10: Can Lactitol be crushed or chewed?
A: Lactitol syrup is typically taken orally. No crushing or chewing is necessary. Ensure that tablets/granules are dissolved in a glass of water before taking them if any formulation other than syrup is used.
